Dissociation: An insufficiently recognized major feature of complex PTSD

Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands.
Journal of Traumatic Stress (Impact Factor: 2.72). 10/2005; 18(5):413-23. DOI: 10.1002/jts.20049
Source: PubMed


The role of dissociation in (complex) posttraumatic stress disorder (PTSD) has been insufficiently recognized for at least two reasons: the view that dissociation is a peripheral, not a central feature of PTSD, and existing confusion regarding the nature of dissociation. In this conceptual article, the authors address both issues by postulating that traumatization essentially involves some degree of division or dissociation of psychobiological systems that constitute personality. One or more dissociative parts of the personality avoid traumatic memories and perform functions in daily life, while one or more other parts remain fixated in traumatic experiences and defensive actions. Dissociative parts manifest in negative and positive dissociative symptoms that should be distinguished from alterations of consciousness. Complex PTSD involves a more complex structural dissociation than simple PTSD.

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    • "For the treatment of complex PTSD, starting with stabilizing interventions prior to EMDR or prolonged exposure has been shown to improve the overall treatment effect (Cloitre et al., 2010; Dorrepaal et al., 2010, 2012). Assessment and treatment of dissociative disorders in traumatized groups is called for in light of the severe clinical condition of such patients and their low treatment success when dissociative disorders are not recognized (Boon & Draijer, 1993; Friedl & Draijer, 2000; Hart et al., 2005; Moskowitz, 2011; Read et al., 2005; Ross & Keyes, 2004; Sar et al., 2003). "
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    • "Dorahy, Middleton, and Irwin (2005) demonstrated slowed response to negative words on a flanker task in individuals with dissociative identity disorder, and Mueller-Pfeiffer et al. (2010) found that slowed response to negative stimuli on the Stroop task was related to task-related depersonalization in PTSD+ individuals. As dissociation is often more severe in individuals with chronic trauma histories (van der Hart, Nijenhuis, & Steele, 2005), dissociation may be related to attention in this group. "
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